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Biological Foundations of Misconduct. Missouri Juvenile Justice Conference October 2012. Special Thanks to: Dr. Barbara Sullivan (Utah Addiction Center) The Dana Foundation. The challenge of working with Adolescents. Parents and professional alike have been puzzled for years………

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Biological foundations of misconduct

Biological Foundationsof Misconduct

Missouri Juvenile Justice Conference

October 2012

Special Thanks to:

Dr. Barbara Sullivan (Utah Addiction Center)

The Dana Foundation


The challenge of working with adolescents
The challenge of working with Adolescents

  • Parents and professional alike have been puzzled for years………

  • Is this NORMAL teenage “baloney” or is it pathological?


Most common mistake
Most common mistake?

  • Viewing Adolescents as small adults

  • Physical size

  • “Act your age”

  • Not only physical, emotional, moral social, but neurological


According to the CDC, 27,000 people between the ages of 10 and 24 die from bad decisions – primarily accidents, homicide, and suicide…… (Anderson & Smith (2005)

.

The adolescent years, in particular, are a period of heightened vulnerability to reckless behavior that occurs despite the fact that adolescents are more cognitively mature than children………. (Spear 2000).


Actuarial tables indicate that adolescents and young adults are more likely to drive recklessly and are more likely to drive under the influence of alcohol or drugs………… (Arnett J , 1993).

Viewed in hindsight, many of these adverse outcomes seem to be a result of a poor decision. Although nobody is immune from making bad decisions, adolescents and young adults seem to make a disproportionate share of ultimately fatal or debilitating ones; indeed, bad decisions are the greatest cause of morbidity and mortality in adolescents. (Berns, Moore & Capra, 2009)


Earliest attempts to explain are more likely to behavior of human beings…………..

Demonology

Trephaning


Possession are more likely to The notion that psychopathology was caused by a possession of a spirit or god was a prevailing theory of mental illness throughout history.


DEMONOLOGICAL MODEL are more likely to The demonological model, as an explanation of psychopathology, has existed since the beginnings of humanity. …..the causes of mental illness are due to "spirits" entering the body and causing the host to becomepossessed.


The cure would be to release the spirit from the individual. The methods for this were accomplished in several different ways includingtrephaning,exorcism , and a number of purgative techniques , that would make the host's body unpleasant for the spirit.


Trephaning was a technique used even in the prehistoric period. A small round hole in the skull would be made in order that the evil spirits could be released. Ironically, this technique could have been successful for certain kinds of psychopathology……….…


The hole in the skull would have reduced the pressure on the brain caused by edema, or swelling,

eliminating the peculiar behavior, or "releasing the spirit".


Biological roots
Biological roots brain caused by edema, or swelling,

Hippocrates

“Humours”….(humors)

Chemical imbalance


The Greek physician Hippocrates, brain caused by edema, or swelling,c. 460 - 377 B.C, is often called the “father of medicine”. Perhaps the most important idea associated with Hippocrates is that of relying on facts, clinical observation and experiment.


HIPPOCRATES AND THE BIOLOGICAL MOVEMENT brain caused by edema, or swelling,Hippocrates had the notion that psychopathology was due to disturbances within the balances of the four humours.


The brain caused by edema, or swelling,Four Humors consisted of BLOOD, PHLEGM, YELLOW BILE and BLACK BILE, that are produced by several organs throughout the body.


Diseases were caused by the over or under manufacturing of one of these substances causing disharmony.


Perspectives
Perspectives one of these substances causing

Today we have several perspectives as ways of explaining human behavior

Psychology has multiple theories of explanation:

Biological

Psychodynamic

Behavioral

Humanistic

Cognitive

Evolutionary


Biological perspective
Biological Perspective one of these substances causing

Study the physiological mechanisms in the brain and nervous system that organize and control behavior

Focus may be at various levels

individual neurons

areas of the brain

specific functions like eating, emotion, or learning

Interest in behavior distinguishes biological psychology from many other biological sciences


Brain has evolved
Brain Has Evolved one of these substances causing


The Human Brain one of these substances causing Weighing roughly three pounds, the human brain is about the size of a small cauliflower. Although your brain makes up only about 2 percent of your total body weight, it uses some 20 percent of the oxygen your body needs while at rest. The oxygen is used in breaking down glucose to supply the brain with energy.


Brain facts
BRAIN FACTS one of these substances causing

Brain weighs approximately 3 pounds

Brain has approximately 100 billion neurons and 1 trillion supporting cells

Neurons grow and organize themselves into efficient systems that operate a lifetime

Brain controls ALL activities

Emotion and cognition are intertwined

Neurons can re-route circuits

Brain and environment involved in delicate duet

Brain never stops adapting and changing


Challenge of understanding the brain
CHALLENGE OF UNDERSTANDING one of these substances causing THE BRAIN

What is the link between the anatomy of a brain and the workings of the mind—our thoughts, emotions, memories, and behaviors?

There are no moving parts—it does not operate mechanically as our hearts, legs, hands, and lungs do.


The parts of the human brain
The Parts of the Human Brain one of these substances causing


Focus
Focus one of these substances causing

  • “White Matter”

  • Frontal Cortex

  • Caudate nucleus

  • Limbic System

    • Amygdala


Two major developmental periods of brain
Two Major Developmental one of these substances causing Periods of Brain

  • First 3 years of life

  • Second burst about 11 for girls and 12 for boys

    • Shaping White Matter

  • Full development about 25



Brain size.size does not equal intellectual or emotional maturity

Although the brain is 80 percent developed at adolescence, research indicates that brain signals essential for motor skills and emotional maturity are the last to extend to the brain’s frontal lobe, which is responsible for many of the skills essential for driving.



Gray matter: size.areas of the nervous system where the nerve fibers are unmyelinated

White Matter: areas of the nervous system composed mostly of myelinated nerve fibers (those having myelin sheaths) constituting the conducting portion of the brain and spinal cord.


White matter size.contains the protein myelin, which coats neurons' spindly axons as they reach toward other areas of the brain. Myelin is important for efficient signaling between neurons, and it is known to grow considerably between childhood and adulthood.

The Myelin Sheath of a neuron consists of fat-containing cells that insulate the axon from electrical activity.


When adults reach age 20, size.white matter begins to spread, from the back of the brain forward, usually completing this process between 25 and 30 years of age.


One of the most familiar “ size.white matter deficiency” diseases………….Multiple Sclerosis


Researchers size.have found a connection between increased white matter and reduced impulsivity

Young people whose brains mature early might be more prone to engage in adult activities and choices.


White matter of a 20-year-old man contains a staggering 176,000 km of myelinated axons (Marner et al., 2003).

Axons ensure smooth communication throughout the brain in two important ways: by conducting electrical impulses and by transporting various molecules and organelles from the cell body to the synapse (Barry et al., 2007).


Hence, the importance of maturational changes in white matter (WM) during childhood and adolescence for the child's cognitive development and mental health

Perrin, Herve, Leonard, et al……2008


" matter (WM) during childhood and adolescence for the child's cognitive development and mental healthWhite matter is composed of bundles of myelinated axons connecting grey matter areas of the brain, and has been shown to continue to develop throughout adolescence. These systematic changes in white matter organization reflect not only maturation of interconnections but continued maturation of the brain as a whole."

"White matter, and its integrity, are essential to the efficient relay of information within the brain…………


"Indicators of white matter integrity are linked to performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. Abnormalities in white matter health could relate to compromised ability to consider multiple sources of information when making decisions, and to emotional functioning."

Susan F. Tapert, associate professor of psychiatry at the University of California


The performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. white matter revelation has led some safety experts to suggest raising the minimum driving age to 18. But others have said this is an unnecessary change that would place an undue burden on parents.

What’s more common is a push for the implementation of stricter graduated licensing laws, which would impose a multi-tiered licensing system to ease teenagers in to the responsibilities of driving without a parent in the car.


"Use it or lose it" performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. principle

Dr. Jay Giedd

Those cells and connections that are used will survive and flourish. Those cells and connections that are not used will wither and die.

So if a teen is doing music or sports or academics, those are the cells and connections that will be hard-wired.

If they're lying on the couch or playing video games or MTV, those are the cells and connections that are going to survive.


The performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. brain undergoes a significant structural re-modeling process which includes a substantial increase in white matter, and an overall decrease in grey matter attributable to the activity-dependent process of synaptic pruning.

Tom Wasiuta


-In performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. many ways adolescence is the healthiest time of life. The immune system, resistance to cancer, tolerance for heat and cold and several other variables are at their peak.

-Despite physical strengths, however, illness and mortality increase 200 percent to 300 percent.

-As of 2005, the most recent year for which statistics are available, motor vehicle accidents, the No. 1 cause, accounted for about half of deaths. Nos. 2 and 3 were homicide and suicide.

Jay N. Giedd, M.D. , National Institute of Mental Health. 


Maturation of the prefrontal cortex
Maturation of the Prefrontal Cortex performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

  • The prefrontal cortex is often referred to as the “CEO of the brain.”

  • This brain region is responsible for cognitive analysis and abstract thought, and the moderation of “correct” behavior in social situations.


Executive functions of the human prefrontal cortex include
“Executive performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. functions” of the human prefrontal cortex include:

  • Focusing attention

  • Organizing thoughts and problem solving

  • Foreseeing and weighing possible consequences of behavior

  • Considering the future and making predictions

  • Forming strategies and planning

  • Ability to balance short-term rewards with long term goals


  • Shifting/adjusting behavior when situations change performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

  • Impulse control and delaying gratification

  • Modulation of intense emotions

  • Inhibiting inappropriate behavior and initiating appropriate behavior

  • Simultaneously considering multiple streams of information when faced with complex and challenging information

U.S. Department of Health & Human Services


Frontal lobe
FRONTAL LOBE performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

Seat of personality, judgment, reasoning, problem solving, and rational decision making

Provides for logic, understanding of consequences, and emotional/behavioral regulation

Governs impulsivity, aggression, ability to organize thoughts, and plan for the future

Controls capacity for abstraction, attention, cognitive flexibility, and goal persistence

Undergoes significant changes during adolescence — not fully developed until mid20’s (Giedd, 2002)


Components of executive functions and sample behaviors
COMPONENTS OF performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. EXECUTIVE FUNCTIONS AND SAMPLE BEHAVIORS


Brown et al., 2008 performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.


The amygdala
The performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. Amygdala

Responsible for:

arousal,

regulation of emotion, and

the initial emotional response to sensory information.

Plays important role in

mediating anxiety and depression.

emotional memory.


Adolescence
ADOLESCENCE performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

Adolescence is much broader and longer than the teenage years alone (has changed significantly over the past 150 years)

Adolescence now stretches across more than a decade, with pubertal onset often beginning by age 9-12 and adult roles delayed until mid twenties

(Worthman, 1995)


Adolescence is a performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. TRANSITIONAL period during which a child is becoming, but is not yet, an adult

Adolescent brains are far less developed than we previously believed

Normal adolescent development includes conflict, risk taking, facing insecurities, creating an identity, mood swings, self-absorption, etc.


Adolescence1
ADOLESCENCE performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

Most elements of cognitive development show a trajectory that follows age andexperience rather than the timing of puberty (Dahl, 2004)

Research (eg, Martin, 2003) demonstrates a significant positive correlation between pubertal maturation and sensation seeking


PUBERTY performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

Romantic motivation

Sexual interest

Emotional intensity

Sleep cycle changes

Appetite

Risk for affective disorders (girls)

Increase in risk taking, sensation seeking, and novelty seeking

AGE/EXPERIENCE

Planning

Logic, reasoning

Inhibitory control

Problem solving

Understanding consequences

Affect regulation

Goal setting and pursuit

Judgment and abstract thinking

Dahl, 2004


Adolescence vs adults
ADOLESCENCE VS. ADULTS performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information.

Being a responsible adult requires developing self-control over behavior and emotions– must be able to appropriately inhibit behaviors despite STRONG FEELINGS

The ability to integrate these multiple components of behavior, cognition, and affectin the service of long term goals involves neurobehavioral systems that are among the last regions of the brain to fully mature(Dahl, 2004)


The most widely implicated factor associated with performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. maladaption vs. resilience in adolescence is REGULATORY CAPACITY (RC) [Kupfer & Woodward, 2004]

Behavioral control (RC)requires tremendous effort; adolescents need practice being consistent and integrating RC

White matter development is needed for regulatory capacity


In the heat of the moment, teen decision-making can be overly influenced by emotions, because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex

  • Sheryl Feinstein, author of Inside the Teenage Brain: Parenting a Work in Progress (Rowman and Littlefield, 2009.)


Critical differences between adult and adolescent thinking

Critical Differences Between overly influenced by emotions, because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex Adult and Adolescent Thinking


  • Jay overly influenced by emotions, because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex Giedd and his colleagues have given us a new window into understanding how the pre-adolescent brain develops. It confirms what other neuroscientists have outlined over the past 25 years -- that different parts of the brain mature at different times.

  • In particular, it corroborates the work of neuroscientists like Peter Huttenlocher who have shown that the frontal cortex of human beings matures relatively late in a child's life.

  • http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/work/adolescent.html


Why is it that a young person is not able to drive a car until 16, vote until 18, drink alcohol until 21, rent a car from a commercial agency until 25, but in some states, can stand trial for murder at age 12 or 13?(Dahl, 2004)


Underdevelopment until of the frontal lobe/prefrontal cortex and the limbic system make adolescents more prone to “behave emotionally or with ‘gut’ reactions”(Yurgelun-Todd, 1999)

Adolescents tend to use an alternative part of the brain– the AMYGDALA(emotions & aggression) rather than the prefrontal cortex(reasoning) to process information



Amygdala until and nucleus acumbens(limbic system within the temporal lobes) tend to dominate the prefrontal cortex functions– this results in a decrease in reasoned thinking and an increase in impulsiveness

Because of immature brains, adolescents do not handle social pressure, instinctual urges, and other stresses the way adults do

A major part of adolescence is learning how to assess risk and consequences — adolescents are not yet skilled at these tasks (Dahl, 2004)


Hot cold cognition
Hot/Cold Cognition until

  • Hot cognition is a relatively new psychological term describing the mental processes that occur when emotions and personal goals influence judgment.

  • Unlike cold cognition that is purely intellectual, it often relies on biases, hunches, feelings, intuition, “gut feelings,” and heuristics.

  • People are especially likely to rely on this type of processing when making decisions that involve powerful emotions and self-interest.


Hot and cold cognition
HOT AND COLD COGNITION until

Thoughts and emotions are intertwined – teens need to develop a balance between cognitive and affective systems of the brain

“COLD” cognition refers to thinking under conditions of low emotions and/or arousal

“HOT” cognition refers to thinking under conditions of strong feelings or arousal

Decisions made under conditions of strong affect are difficult to influence by cool rational thought alone


Decision making in teens cannot be fully understood without considering the role of emotionsand the interaction between thinking and feeling (Dahl, 2003)

Teen decisions are unlikely to emerge from a logical evaluation of the risk/benefits of a situation – rather decisions are the result of a complex set of competing feelings – desire to look cool, fear of being rejected, anxiety about being caught, excitement of risk, etc.


Adolescent brain is a considering the role of “vulnerable” system that could fail under “hot” high demanding situations – where the circuitry is not sufficiently established to sustain adult level cognitive control of behavior in the face of heightened states of emotion, motivation, distracting stimuli, or competing tasks

(Luna & Sweeny, 2003)


Researchers know that the integrity of the brain's white matter is compromised in adult alcoholics, but it is unclear when during the course of drinking white matter abnormalities become apparent. A study of adolescent binge drinkers has found that even relatively infrequent exposure to large doses of alcohol during youth may compromise white matter fiber coherence.

Susan F. Tapert


PFC matter is compromised in adult alcoholics, but it is unclear when during the course of drinking white matter abnormalities become apparent. A study of is linked to the ability to inhibit impulses, weigh consequences, prioritize, and strategize – this area is still “under construction” until late 20’s (Giedd, 1999)

Wernicke’s area (reception of speech) and Broca’s area (production of speech) undergo substantial changes during the teen years – impacts ability to listen and express oneself


Adolescents are not very skilled at distinguishing the subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of miscues—leads to lack of communication and inappropriate behavior

Differences in processing, organization, and responding to information/events leads to misperceptions and misunderstanding verbal and non-verbal cues


To subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of appreciate consequences of risky behavior, one has to have the ability to think through potential outcomes and understand the permanence of consequences,

due to an immature prefrontal cortex, teens are not skilled at doing this

Teens do not take information, organize it, and understand it in the same way that adults do—they have to learn how to do this


Adolescent brain development
ADOLESCENT BRAIN DEVELOPMENT subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of

Important to understand that teens often fail to heed common sense or adult warnings because they simply may not be able to understand and/or accept reasons that seem logical and reasonable to adults (difference in evaluating positive & negative consequences {Fromme et al., 1997})

Adolescents may know “right from wrong”, but they may not be able to prioritize when stressed with social/peer pressure

NEVER assume that you and a teen are having the same understanding of a conversation


Phineas gage
Phineas Gage subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of

Gage was a railroad construction foreman

An 1848 explosion forced a steel tamping rod through his head

Others said he was “…no longer Gage…”

Lost his job, worked as a sideshow exhibit


Phineas gage1
Phineas Gage…………. subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of

Damage to orbitofrontal area—

Impaired sensitivity to risk, reward, and punishment

Impulsivity and insight

Lash out in response to perceived slights


A Model of Gage’s Injury Computer simulated subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of

reconstruction of Gage’s skull by Damasio and her colleagues (1994) suggests that Gage’s left and right frontal lobes were both damaged.


Frontal lobe injury
Frontal Lobe Injury subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of

Phineas Gage

http://www.youtube.com/watch?v=5B2pQkqM6nc&feature=related


The prefrontal cortex in close up
The Prefrontal Cortex in Close-Up subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of

Phineas Gage: His accident led to major personality changes

Prefrontal cortex: brain region particularly concerned with social phenomena (e.g., following norms). Patients with injury to this region often have profound disturbances in their ability to get along with others

Lobotomy: deliberate damaging of the prefrontal cortex; used in the late 1940s early 1950s

Left patients lethargic and emotionally flat, and much easier to manage in mental hospitals, but it also left them disconnected from their social surroundings


As the “prefrontal cortex” area of the frontal lobe matures, through experience and practice, teens can reason better, develop more impulse control, and make better judgments

Prefrontal cortex is one of the last areas of the brain to fully develop (Sowell, 2001)

Increased need for structure, mentoring, guidance


Anderson RN, Smith BL (2005) Deaths: leading causes for 2002. Hyattsville, Maryland: National Center for Health Statistics.

Spear LP (2000) The adolescent brain and age-related behavioral manifestations. NeurosciBiobehav Rev 24: 417–463.

Arnett J (1993) Reckless behavior in adolescence: a developmental perspective. Developmental Review 12: 339–373

Adolescent Engagement in Dangerous Behaviors Is Associated with Increased White Matter Maturity of Frontal Cortex. Berns, Moore &I Capra


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